Health Care – When Disaster Strikes
Almost seven years post the attacks of September 11th, one of the serious preparedness issues still facing the country is the state of its health care, especially hospital trauma centers that would not be able to deal with the surge of patients resulting from a mass casualty terrorist attack.
A recent controversial inquiry into the disaster preparedness of hospitals concluded that they are -- and will be -- incapable to handle even a modest terrorist attack in those cities (none of the 34 hospitals in the survey by the House Committee on Oversight and Government Reform found that none of them were found ready to act at the moment of an attack); one reason for the lack of hospitals' capacity was cited as the Administration’s cuts in Medicaid reimbursements that in turn create overcrowding in emergency rooms, compromising the hospital’s ability to absorb and treat disaster victims.
"The situation in Washington, D.C. and Los Angeles was particularly dire. There was no available space in the emergency rooms at the main trauma centers serving Washington, D.C. One emergency room was operating at over 200 percent of capacity - If a terrorist attack had occurred in Washington, D.C. or Los Angeles on March 25 when we did our survey, the consequences could have been catastrophic. The emergency care systems were stretched to the breaking point and had no capacity to respond to a surge of victims."
The study has been denounced by Congressional Republicans as a “political stunt”. In response to the survey, Representative Christopher Shays (R-Connecticut) said "We cannot afford to build and maintain idle trauma facilities, waiting for the tragic day we pray never comes."
Dr. Richard Bradley, an emergency physician and chief of the division for EMS and disaster medicine at the the University of Texas Health Science Center at Houston, said it's incorrect to assume the city can't handle a surge simply because emergency rooms here often operate at capacity.
Related, we also learn that in the May edition of Chest, the Journal of the American College of Chest Physicians, disaster triage recommendations are made.
Those out of luck are the people at high risk of death and a slim chance of long-term survival. But the recommendations get much more specific, and include:
- Those with severe trauma, which could include critical injuries from car crashes and shootings
- People older than 85
- Severely burned patients older than 60
- Those with severe mental impairment, which could include advanced Alzheimer's disease
- Those with a severe chronic disease, such as advanced heart failure, lung disease or poorly controlled diabetes
The ability of our health system to deal with a man-made or natural disaster should not become a political football. Even though these “recommendations” are problematic and likely violate federal laws against age discrimination and disability discrimination, along with other ethical and moral issues, the likelihood is that health care rationing will be needed in the event of a mass casualty disaster.